Quick disclaimer: this is all opinion and entertainment. Not legal, tax, HR, or compliance advice. No affiliate links, no kickbacks, no sponsorships. I’m also not attacking any company here — the agencies I mention provide a genuinely good service. I just want to show you what’s underneath the service, because once you see it, you may decide you’d rather do it yourself.
If I had to pick the single highest-ROI operational change I’ve made running a multimillion-dollar primary care practice in Texas, it wouldn’t be a new EMR or a marketing campaign. It’s this: we now run roughly a dozen virtual assistants, and they cost me about what two in-person front desk employees used to.
Most practice owners who look into virtual assistants for medical practices go straight to an agency, pay the agency rate, and never learn where the agency found that person. This post is the other path.
Most practice owners quote themselves the wrong number. They say “my MA makes $25 an hour.” That’s not what she costs.
Here in Texas, a medical assistant or front desk person in my market runs about $25/hour base. Then you add employer FICA — 7.65% in Social Security and Medicare tax, call it another $2/hour. Then PTO, where every paid hour produces nothing. Then benefits. Then workers’ comp, unemployment insurance, and payroll processing fees.
Stack all of that and you’re at $30, $31, maybe $32 an hour all-in for that seat. For context, O*NET’s Texas wage data for medical assistants puts the 2025 state median around $19/hour — so if you’re in a competitive metro paying $25 base, you’re already above market and your loaded cost is well north of $30.
Hold that number: $32 an hour.
For the same $32/hour, you can staff four to five full-time virtual assistants. Not part-time. Full-time.
I know how that sounds. The rest of this post is about whether it’s actually a good idea, and how to do it without blowing up your practice.
The mistake people make is thinking of a VA as “the person who answers the phone when nobody else can.” That’s the smallest version of this.
Here’s what ours actually handle:
The talent pool is not what you’re picturing. Almost all of ours are licensed medical professionals in the Philippines — physical therapists, pharmacists, nurses — choosing remote administrative work for a U.S. practice because it pays better than their local clinical job. One of mine told me flat out that he earns more working from home for my practice than he did as a physical therapist in a hospital.
And when you require billing experience, you get applicants who say “I spent three years at UnitedHealthcare processing claims.” They were on the other side of the phone. They know exactly how the denial machine works, because they used to run it.
The first company I used was Hello Rache, and they were great — easy onboarding, excellent communication, credit card billing, a clean dashboard with time cards and activity screenshots. If you want zero friction, that’s a legitimate reason to use an agency. Their published rate is $9.50/hour.
Here’s what I noticed. When I later started hiring directly, the time tracking looked identical. The screenshot monitoring looked identical. The onboarding flow, the background check output, the video introductions — all of it looked like the same infrastructure I’d seen through the agency.
I can’t prove anything, and maybe everyone in this industry licenses the same tools. I’m not accusing anyone of anything — this is my observation and my opinion, nothing more. But my strong suspicion is that a meaningful chunk of the agency model is: source talent from a public job board, mark up the rate, manage the relationship for you.
If that’s true, the question is simple: that $2–4/hour spread, who should get it?
The part I like about going direct is that you don’t have to keep all of it. I typically pay $6, $7, sometimes $8/hour — still well below the agency rate, and more than what I understand the worker was taking home through the agency. They make more. I pay less. Nobody got worse off except the intermediary. That’s not a hack. That’s removing a layer.
A reader taught me about this platform — a good reminder that the best operational ideas come from other practice owners, not consultants. (Speaking of which, I have strong opinions about the consultant economy in medicine.)
OnlineJobs.ph is a job board for Filipino remote workers, not an agency. You post, they apply, you interview, you hire, you pay. The platform advertises over 5 million worker profiles and more than 600,000 businesses that have used it.
Their pricing has three tiers as of this writing:
| Plan | Cost | What you get |
|---|---|---|
| Free | $0 | Post up to 3 jobs, see up to 15 applications, cannot contact applicants |
| Pro | $69/mo or $299/yr | 3 job posts/month, 200 applications per post, contact 75 workers/month |
| Premium | $99/mo or $349/yr | 10 job posts/month, 200 applications per post, contact 500 workers/month, unlimited background data checks, worker coaching, contract templates |
The free tier is a demo — you can’t message anyone, so you can’t actually hire. Get Premium. It’s $349 for the year. If it saves you one $32/hour seat for one month, it’s paid for itself ten times over. Premium is also what unlocks unlimited background data checks, which matters for the compliance section below.
Here’s mine verbatim, because somebody gave me theirs for free and I’d feel bad hoarding it.
We are a primary care doctor’s office looking for an experienced, competent, detail-oriented, and kind administrative assistant for verifying insurance benefits and scheduling patient appointments. The ideal candidate is efficient and detail-oriented, with experience in the medical field, and able to independently manage tasks and deadlines. Previous experience working graveyard shifts and excellent English are a must. Previous experience working with medical practices and dealing with insurance is preferred.
Please apply with 7 apply points.
Please describe your previous experience working graveyard shifts and your general background.
Tasks include but are not limited to staffing our phone lines from 8am–5pm Central Time.
*** Please send a video sample of you speaking English with your application. Applicants without a video will not be considered. ***
Then I list the actual duties — complete check-in paperwork, insurance verification, appointment scheduling — plus all the disclaimers.
Starting rate posted: $5/hour.
Applicants on the platform have a limited number of “apply points” and choose how many to put behind each application. It’s a ranking mechanism: more points signals they’re serious about your job specifically. So I put in the post: must apply with 7 points.
This is the single best filter in the process and it costs you nothing. Anyone applying with 4 or 5 points either didn’t read the post or wouldn’t follow one simple instruction. Delete. You just cut the bottom half of your applicant pool with one sentence.
Same logic on the video. It takes three minutes to record a short Loom. If they won’t do three minutes for a job they want, they won’t do the unglamorous parts either. And practically: if your VA is on the phone with elderly patients all day, you need to hear them speak first. Some applicants are wonderful people who are simply hard to understand on a phone line — not a character judgment, just a bad fit for a phone-facing role.
Last time we posted a phone role at $5/hour, we got 156 applications in the first 48 hours.
That tells you two things. The talent pool is deep enough to be genuinely picky, and your filters are not optional — without them you will drown.
You pay through the platform via ACH from your bank account, straight into theirs. My payroll cost for these employees is zero. No PEO fee, no per-head payroll charge, no benefits administration.
Let’s put the whole thing side by side.
| In-house front desk (TX) | Direct-hire VA | |
|---|---|---|
| Base rate | $25/hr | $5–8/hr |
| Employer FICA | ~$2/hr | $0 |
| PTO / benefits | ~$4–5/hr | $0 |
| Payroll processing | Per-head fee | $0 |
| Platform cost | — | $349/yr flat |
| All-in | ~$32/hr | ~$5–8/hr |
At 2,080 hours a year, that in-house seat is roughly $66,000. The VA seat at $7/hour is roughly $14,500. We run about twelve of these individuals. Do that math against twelve in-house seats and you’ll see why it’s a bigger lever than almost anything else on your P&L.
One honest caveat: “four to five VAs for the price of one employee” is a ceiling, not a plan. You cannot replace an in-person MA who rooms patients and draws blood with a person in Manila. You can replace the phone-and-paperwork portion of that job. Figure out which of your labor hours are actually location-dependent before you get excited.
This is where most practice owners stop, and it’s a fair place to be cautious. Again: not legal advice, talk to your own healthcare attorney.
First, the framing that changed my mind. When I call Blue Cross or UnitedHealthcare to fight a claim, I am very often speaking with someone in the Philippines or India — and that rep has access to my patient’s protected health information. Somehow it’s acceptable when a $300 billion payer does it. So the question isn’t whether offshore staff can handle PHI. The industry answered that already. The question is whether you have built the same controls they have.
Second, HIPAA doesn’t have a border rule. HHS guidance on business associates defines a business associate as anyone who creates, receives, maintains, or transmits PHI on your behalf, and requires a signed Business Associate Agreement before you disclose PHI to them. That guidance carves out no geographic exemption — and grants none either. What it makes clear is that you remain responsible: if you know of a pattern that materially breaches the agreement, you must cure it or terminate the relationship.
Translation: offshore isn’t prohibited, but the entire diligence burden lands on you.
What we actually do:
That last one leads to my only real horror story.
We’ve hired roughly twenty people through the platform and have essentially never had a bad hire on work quality. But a handful of times, a worker couldn’t be paid through the normal ACH rail — every attempt failed — and then they’d ask if we could pay through PayPal or some other back channel instead.
We let every one of those people go.
To receive payment through the platform, a worker uploads ID and clears a know-your-customer check, the same identity verification a bank performs. If the financial system has looked at this person and declined to process their transactions, I’m not in a position to overrule that. It doesn’t matter that they passed the background check or that their work was fine.
Make this a hard rule before you hire, because you will be tempted to bend it for someone you like. While we’re on things that look fine until they aren’t, I wrote up the patient-side scams we’ve run into too. Same instinct: when something is structurally weird, believe the structure.
I’m not anti-AI. I’m a businessman — if something is cheaper, always-on, and delivers a better patient experience, I’ll adopt it tomorrow. But I keep landing in the same place on AI phone agents specifically.
When I call a business and hear “Hi, this is Tina, I’ll be your virtual assistant,” my immediate response is: no. Operator. Human. Maybe that makes me sound like a boomer, but the data suggests I’m not unusual. A 2024 Gartner survey found 64% of customers would prefer companies didn’t use AI for customer service at all, and more recently 87% said companies using generative AI for service must provide access to a human agent.
I’ve watched it play out locally. A dermatology group here in Texas switched their phones to an AI agent and abandoned it after about thirty days — new patient visits, year over year and seasonally adjusted, dropped dramatically. People called, didn’t want to deal with it, hung up. That’s their reported experience, not a controlled study, but I take it seriously. And my own wife left her OBGYN when that office switched to an AI phone agent. Didn’t complain, didn’t call back. Just left — and I’d asked hoping she’d say it was great, because I’m always shopping for a cheaper 24/7 solution.
Here’s the frame. A new patient phone call is the highest-value inbound event in your practice, and an abandoned one costs you that patient’s entire lifetime value. If a live human on the second ring costs $6/hour, the AI agent isn’t competing against $32/hour — it’s competing against $6/hour, and it has to be better, not just cheaper.
What my patients actually tell me is “y’all picked up on the second ring.” In a market where every other office sends you to a menu tree, a warm voice is a competitive advantage. I use AI aggressively for documentation, coding, and back-office automation. The phone is different.
I am not telling you to stop hiring Americans. We have a large in-office team here in Texas and we’re still hiring. Clinical care is in-person. Rooming patients is in-person. Drawing blood is in-person. Your practice manager should be in-person — I wrote a whole piece on when it’s time to hire an office manager, and none of that changes. The claim is narrower: the mind-numbing, on-hold, keyboard-and-headset work does not need to consume a $32/hour local seat. Move that work, then use the savings to pay your in-person team better.
Will you get complaints? Yes. A few patients will object to an accent, and you won’t reason them out of it. Weigh that handful against the much larger group relieved that a person picked up at all. In my experience it isn’t close.
Is this arbitrage? Yes, and I’ll own the word. But it runs in a direction I’m comfortable with: I pay above the platform norm, above what I believe the middleman was passing through, and my VAs tell me they earn more than they did in their prior clinical roles. Some have been with me five years. Go into this trying to pay the absolute floor and you’ll get floor-quality results — and you’ll deserve them.
How much does a medical virtual assistant cost? Through an agency, roughly $9.50/hour and up. Hiring directly through a job board, $5–8/hour depending on experience and shift, plus a flat subscription around $349/year. No employer FICA, no benefits load, no payroll processing cost on the direct-hire side.
Can a virtual assistant be HIPAA compliant? A person isn’t “HIPAA certified” — your process is what’s compliant or not. You need a signed BAA, documented training, access controls, a private work environment, and monitoring. HHS guidance places responsibility on you as the covered entity and doesn’t exempt offshore contractors. Talk to a healthcare attorney about your setup.
What hours do Philippines-based VAs work? Philippine Standard Time runs about 13–14 hours ahead of U.S. Central, so your 8am–5pm is their overnight. That’s why “previous graveyard shift experience” belongs in your job post. Plenty of candidates have it — the BPO industry there runs on U.S. hours — but screen for it explicitly.
What about countries other than the Philippines? The same model exists elsewhere, with equivalent job boards for India, Mexico, and Central and South America — worth exploring if your patient population needs Spanish-language capability.
Should I just use an agency instead? If you have no bandwidth to recruit, onboard, and manage, an agency is a reasonable purchase and nobody should feel bad about it. You’re paying roughly $2–4/hour for someone else to do that work. Just make the decision knowingly instead of assuming it’s the only option.
Post the job. Require seven apply points. Require a video. Sign a BAA. Run the background check. Do your own HIPAA training. Pay through the official rail only. Pay a dollar or two above the going rate so you keep good people.
That’s the entire playbook for hiring virtual assistants for medical practices without a middleman. It cost me $349 a year and a couple of weekends to learn, and it changed my cost structure more than anything else I’ve done.
Somebody handed me their job post template for free and it’s been worth six figures to my practice. So mine is above — take it, change what you need. No affiliate links, no kickbacks, nothing owed.
If this was useful, you’d probably also get something out of Top 10 Tips for Growing Your Medical Practice and Stop Running Your Medical Practice on Autopilot, or my 5.5-year update on growing the practice.
All opinion, for entertainment purposes only. Not legal, tax, or compliance advice. No affiliate relationships with any company mentioned.
